Provider Demographics
NPI:1265282594
Name:MOORE, LYDIA JANE ZHEN (LMSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:JANE ZHEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:JANE ZHEN
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:IA
Mailing Address - Zip Code:52358-0130
Mailing Address - Country:US
Mailing Address - Phone:319-643-2532
Mailing Address - Fax:319-643-5708
Practice Address - Street 1:233 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:IA
Practice Address - Zip Code:52358-9620
Practice Address - Country:US
Practice Address - Phone:319-643-2532
Practice Address - Fax:319-643-5708
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0987641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical